Doctor, doctor

Friday 22 May 2009 19.01 EDT
First published on Friday 22 May 2009 19.01 EDT

Will having the snip give my gyp?

I've decided to have a vasectomy (we have three children), but I hear that some men have pain for a considerable time afterwards. Is this true, and what are the chances of it happening to me?

Most men go through an uncomfortable few days after the operation, but it settles, so that after a week they are without pain. However, a minority (reports suggest it affects around one in 20 men) can develop post-vasectomy pain syndrome, or PVPS. We don't know what causes it: a nerve may be trapped at the site where the tubes are tied. Men with PVPS may need nerve blocks or even, in a small minority of cases, the vasectomy to be reversed to relieve the pain. But the fact that some men develop this shouldn't put you off.

Assessing heart attack risk

My father and two uncles died from heart attacks, and my grandfather may have had one, too. What is my risk? I'm male, 55, slim, don't smoke and have normal blood pressure. My wife says heart attacks are more a matter of lifestyle than inheritance, and that we live very differently from the previous generation. She says I shouldn't worry.

She is mainly correct, but much depends on when your relatives had their heart attacks. If they were under 55 (or women under 65), then you may be at more risk than most, regardless of your lifestyle. If that is the case, ask your doctor to assess your risk. He or she will look at your previous medical history, blood pressure, drinking habits, waistline and cholesterol level. You may be asked to have an exercise ECG if there are any signs of heart disease.

Should someone with epilepsy drive?

My cousin has had two fits recently and her doctor has told her not to drive. She is still driving. She says she only had the fits in bed at night, when she wasn't driving, so she should be safe. Is she right? I don't want to "shop" her if I don't have to.

If this is a new case of epilepsy, she must not drive until she has been fully assessed by the appropriate specialist. Her doctor would have asked her to inform the Driver and Vehicle Licensing Agency (DVLA) about her convulsions and that she was under investigation. She could have a fit behind the wheel and be a danger to herself and others. Please make sure she contacts the DVLA. If she continues to drive, you have no choice but to tell someone yourself.

Why did our GP ask my son if he takes drugs

My 19-year-old son has been very anxious lately, because he can't get a job. He went to his doctor to ask about pains in his chest and I am shocked and insulted because she asked him if he'd been using crack cocaine. He isn't that sort of person. Why did she have to ask that?

Crack cocaine use is a common cause of chest pain in older teenagers and young adults, especially in people who seem over-anxious. Your son's doctor felt she had to rule out this cause. Be happy that she has the knowledge and experience to be aware of this possibility, and is able to ask about it. To be frank, if your doctor can't ask your son straight questions for fear of insulting you, then you don't have a good relationship with her... and mothers don't necessarily know everything about their sons' lifestyles.

• Dr Tom Smith's latest book, Going Loco: Further Adventures Of A Scottish Country Doctor, is published by Short Books at £12.99. Do you have a question for Dr Smith? Email doctordoctor@theguardian.com